London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1927
[Report of the Medical Officer of Health for London County Council]
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interspersed with periods of recurrent minor symptoms. The rarity of rheumatic
manifestation below the age of five years is well known, and no case under five years
appears in this series, no doubt largely because these were clearly declared cases.
The ages of the children are here classified.
| Years of age. | V. | VI. | VII. | VIII. | IX. | X. | XI. | XII. | XIII. | XIV. | XV. |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Number of boys | 1 | 3 | 5 | 0 | 4 | 2 | 8 | 5 | 5 | 3 | 1 |
| Number of girls | 1 | 3 | 8 | 4 | 3 | 5 | 13 | 9 | 8 | 7 | 2 |
| Totals | 2 | 6 | 13 | 4 | 7 | 7 | 21 | 14 | 13 | 10 | 3 |
The numbers are very small and the distribution is perhaps chance, but there does
appear to be a small peak about seven years and a more definite peak at the 11-14
years' period. The duration of illness varied from a few months to over eight years,
and the longer the duration of rheumatism the surer becomes the diagnosis, but the
absence of symptoms prior to five years of age and the falling off in numbers between
eight and eleven seems definitely against the argument that duration of illness was
the deciding factor at all events in this seven year old peak.
These children were recommended not only because beds were now available,
but also because their several conditions were sufficiently urgent to indicate hospital
treatment, and so it might well be that at these ages of physiological stress the
natural resistance of the body to adverse circumstances is lowered and rheumatism
gains sway.
The main clinical conditions seen at examination are tabulated as under:—
| Nutrition. | |||||||
| Number of children | 21 | 56 | 23 | ||||
| Number of children | 89 | 78 | 13 | 9 | 53 | 7 | 7 |
| 4+ | |||||||
| Number of children | 15 | 14 | 2 | ||||
| Number of children | 17 | 43 | 16 | 24 | |||
| Number of children | 37 | 63 | 49 | 30 | 21 | ||
| Number of children | 19 | 42 | 39 | ||||
Only 21 of these children were thought to be of average or better than average
nutrition. Seventy-nine were below average, of whom 23 were excessively thin.
Pallor was noted in 89 cases. Its prevalence may possibly have influenced the
skin classification, since 78 were thought to have fair-fine skins, often showing
excessive, delayed or irregular response to irritation, e.g., demography in varying
degrees was frequently present; cold hands and feet were not uncommon, as was the
presence of chilblains; sweating of the palms of the hand was noted in 53 cases;
and seven children showed rashes varying from irregular erythema of a nervous
or sweating nature to a definite urticaria seen in two children ; erythema nodosum
was not present in any of these children.
Drs. Vincent Coates and R. E. Thomas, of Bath, have reported the high percentage
of their rheumatic children showing nodules, and this feature was specially
looked for. Slight irregularities, little striae and tiny millet seed-like nodules
felt in the subcutaneous tissues over long bones, are a not uncommon feature in thin
children generally, but their pathological significance is doubtful, and only definite